Academic journal article Journal of Drug Issues

Relationship between Low-Income Patient Census and Substance Use Disorder Treatment Programs' Availability of Tobacco Cessation Services

Academic journal article Journal of Drug Issues

Relationship between Low-Income Patient Census and Substance Use Disorder Treatment Programs' Availability of Tobacco Cessation Services

Article excerpt


The pervasiveness of smoking among U.S. adults has decreased by more than 50% over the past five decades. In 1965, 42.4% of adults smoked compared with 19% in 2011 (American Lung Association, 2011 ; Centers for Disease Control and Prevention [CDC], 2012; Moreno & Houston, 2012). Despite these significant reductions, the prevalence of smoking remains high among certain subpopulations. Among individuals seeking treatment for substance use disorders (SUDs) the smoking rate is between 65% and 87% (Fiore et ah, 2008; Guydish et ah, 2011), among lowincome adults receiving Medicaid benefits it is 36% (American Legacy, 2010), and among those who are uninsured it is 33% (American Legacy, 2010).

Unfortunately, adults suffering from SUDs not only have a higher prevalence of tobacco use than adults in the general population but they also often have low incomes and limited access to tobacco cessation treatment (American Legacy, 2010). As a result, they are at a greater risk of negative but preventable health-related outcomes than other populations. The current study examines the relationship between low-income SUD patient census and SUD treatment programs' availability of tobacco cessation services (TCS) that are recommended by the Public Health Service (PHS; Fiore et ah, 2008) to gain a better understanding of the factors that support access to TCS.

Evidence-Based TCS

The clinical practice guidelines on TC published by the PHS encourage clinicians and other professionals to adopt and implement a variety of evidence-based treatments (EBTs), including behavioral treatments, system-level support, and pharmacotherapy ( Fiore et ah, 2008). Behavioral treatments generally include using the 5 As ( ask about tobacco use, advise to quit, assess willingness to quit, assist in quitting, and arrange for follow-up care), increasing patients' problem solving skills, offering counseling services, and providing ongoing TC support and encouragement (Fiore et ah, 2008; Kalman, Morissette, & George, 2005; Richter & Arnsten, 2006). System-level support includes treatment programs providing counselor training on TC, counselor resources for TC, and clinical supervision on TC (Fiore et ah, 2008). Furthermore, the U.S. Food and Drug Administration (FDA) approved seven first-line pharmacotherapies including five nicotine replacement therapies (nicotine gum, inhaler, lozenge, nasal spray, patch), bupropion, and varenicline. Second-line TC therapies include clonidine and nortriptyline that have proven efficacy but are not approved by the FDA as TC aids (Fiore et ah, 2008). Because patients' needs vary and there is no one best TC treatment service, patients should be offered as many services as possible (Fiore et ah, 2008).

Demand for TCS Among Low-Income SUD Patients

Tobacco use among low-income adults continues to be higher than among other adults (CDC, 2012; Moreno & Houston, 2012) and is likely to increase over time (Franks et ah, 2010; Moreno & Houston, 2012). Research finds that lower compared with higher socioeconomic status ( SES) is related to greater TC obstacles including psychological and behavioral ( Yong et ah, 2013), less intent to quit tobacco use, and less abstinence from tobacco at both 1 and 6 months follow-up (Reid et ah, 2010). Concurrently, low-income individuals have less access to health care in general, and TCS in particular ( American Legacy, 2010). This puts them at increased risk of wellknown tobacco-related diseases (U.S. Department of Health and Human Services [USDHHS], 2004).

Considering the high smoking rates among low-income adults and the fact that individuals with SUDs start smoking earlier than the general population, are more likely to be heavy smokers, and often have more difficulty quitting (Breslau, Peterson, Schultz, Andreski, & Chilcoat, 1996; Hayford et ah, 1999; Hays et ah, 1999; Novy, Hughes, & Callas, 2001), providing TCS to low-income patients in SUD treatment should be a public health priority. …

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